Chapter 5. Hypertension
A 55-year-old white man with seated office blood pressure (BP) readings of 138/89 mm Hg and 136/84 mm Hg is asked to return in 2 weeks for repeat measurements, which are 138/88 mm Hg and 134/82 mm Hg. Which of the following classifies his BP per the 2017 ACC/AHA guidelines?
Option A: Incorrect. Stage 2 hypertension is defined as systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg.
Option B: Correct. The patient's average BP falls within the range of systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg, defined as stage 1 hypertension.
Option C: Incorrect. Elevated hypertension is defined as systolic BP of 120–129 mm Hg and diastolic BP of less than 80 mm Hg.
Option D: Incorrect. Optimal BP is defined as BP less than 120 in systolic and less than 80 mm Hg in diastolic.
A 34-year-old black man presents to your clinic with a BP of 160/94 mm Hg. Repeat readings over the past 2 weeks average 156/92 mm Hg. The patient has no past medical history with the exception of Crohn disease, which is currently treated with chronic steroid therapy. He is also taking an over-the-counter NSAID for ongoing back pain. Physical examination and laboratory tests are unremarkable. Appropriate interventions at this time include:
A. No intervention because patient most likely has drug-induced hypertension
B. NSAID is appropriate as long as he follows the instructions on the package insert
C. Reassessment of the dose and need for long-term oral steroids
D. Initiation of antihypertensive therapy
Option A: Incorrect. Consistent elevations in BP require intervention with either treatment or evaluation of whether hypertension is secondary to alternative cause.
Option B: Incorrect. NSAID should be avoided as this can result in elevated BP and an increased risk of cardiovascular events.
Option C: Correct. It is reasonable to inquire for the need of long-term steroids and dose as this is a possible secondary cause for elevated blood pressures.
Option D: Incorrect. Prior to initiation of therapy, the secondary cause of hypertension should be ruled out or reassessed to see if treatment is necessary.